Arthroscopic Bone Grafting in Bilateral Proximal Pole Scaphoid Fracture Nonunion: An Illustrated Description.

INTRODUCTION

We are presenting a case with bilateral scaphoid proximal nonunion which was treated by arthroscopic bone grafting and fixation, done concurrently at the same setting by two wrist surgeons adept in wrist arthroscopy. Our report describes the set up for the operation and the technique involved in arthroscopic bone grafting of proximal pole scaphoid nonunions.

METHODS

An 18-year-old male presented to the clinic with bilateral longstanding wrist pain. Imaging of both hands revealed a nonunited proximal pole scaphoid fracture with some signs of ischemia in the scaphoid bones of both hands. The patient underwent successful bilateral arthroscopic bone grafting and fixation. Supplemental video illustrations of operative procedure have been attached.

RESULTS

Computed tomography performed 3 months postoperatively showed incomplete osseous bridging indicating fracture healing. Post-implant removal at 6 months, the patient had full pain-free range of motion. Radiograph showed fracture healing. Visual analog scale and Mayo Wrist Score were used to objectively quantify patient outcomes and showed improvement.

DISCUSSION: Arthroscopic surgery is a viable alternative to open techniques and offers several advantages including smaller incisions, cosmetically favorable scars, reduced soft tissue injury, and reduced postoperative pain. It can be even more challenging if the presentation is bilateral. To reduce operative time and postoperative recovery, both scaphoids can be operated upon in the same setting. This requires a favorable operative setup and the presence of two wrist surgeons skilled in wrist arthroscopy.

CONCLUSION

This case highlights the setup and the successful use of arthroscopic bone grafting and fixation to treat bilateral proximal pole scaphoid fracture nonunions where some surgeons would have opted for open techniques, staged procedures, or even doing consecutive procedures increasing the operative time and at times the total recovery time. The arthroscopic approach provides a promising alternative to open surgical techniques, which may be worth its learning curve. It also illustrates the approach to surgery in case of bilateral presentations.